Individual
ERIC A ELSEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2517 NE KRESKY AVE, CHEHALIS, WA 98532-2409
(360) 748-8632
(360) 748-3869
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3010
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0117713
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30005759
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004358
—
WA
01
—
G8897483
MEDICARE WA
WA
01
—
G8898112
MEDICARE WA
WA
01
—
G8900477
MEDICARE WA
WA
01
—
G8967168
MEDICARE WA
WA
Enumeration date
01/30/2006
Last updated
11/23/2020
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